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The two main types of inflammatory bowel disease (IBD) are ulcerative colitis and Crohn's disease. Both conditions have the potential to cause serious morbidity and impaired quality of life for patients. With an estimated annual healthcare cost of $6 billion, there is a significant economic burden on the U.S. healthcare system. The main contributors to this cost are hospitalizations and surgery. Traditional management of IBD relies on step-up therapy. To our knowledge, intra-class efficacy has been established for TNF-inhibitors and thiopurines; however, there is limited evidence comparing cross-class efficacy. This proposed study will investigate the incidence of hospitalization and surgical interventions between a thiopurine (azathioprine), TNF inhibitor (infliximab), a novel anti-integrin (vedolizumab), and placebo.